459 - Certified Child Life Specialist in a Pediatric Emergency Department: Impact of a quality improvement initiative to improve procedural pain and distress management for needle procedures

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 459
Publication Number: 459.309

Celine Themelin, Universite de Montreal Faculty of Medicine, Montréal, PQ, Canada; Jocelyn Gravel, Universite de Montreal Faculty of Medicine, Montreal, PQ, Canada; Kaitlen Gattuso, CHU Sainte-Justine, Montreal, PQ, Canada; Marie-Joëlle Doré-Bergeron, CHU Sainte-Justine, Montréal, PQ, Canada; Patricia Laforce, CHU Sainte-Justine, Montreal, PQ, Canada; Nathalie Gaucher, CHU Sainte-Justine, Montreal, PQ, Canada; Julie Paquette, CHU Sainte-Justine, montreal, PQ, Canada; Charlotte Grandjean-Blanchet, CHU Sainte-Justine, Montreal, PQ, Canada; Marie-France Langlet, Children's Hospital, Montréal, PQ, Canada; Sarah Loemba, CHU Sainte-Justine, Montreal, PQ, Canada; Annie Lacroix, CHU Sainte-Justine, montreal, PQ, Canada; corinne Thériault, Children's Hospital, Montréal, PQ, Canada; Evelyne D.Trottier, CHU Sainte-Justine, Montreal, PQ, Canada

Presenting Author(s)

Evelyne D.Trottier, MD (she/her/hers)

Pediatric Emergency Physician, Associate professor
CHU Sainte-Justine, Université de Montréal
Montreal, Quebec, Canada

Background: Needle procedures are a cause of pain and distress for children in the emergency department (ED). Combined strategies such as preparation, comfort positions, distraction, relaxation techniques and topical anesthetic can help children cope with various painful and stressful procedures. A trained professional such as a Certified Child Life Specialist (CCLS) can facilitate the uptake of these strategies.

Objective:

To evaluate the use of strategies to reduce procedural pain and distress for children in the pediatric ED of a tertiary care pediatric hospital with the implementation of an institutional quality improvement (QI) initiative that worked closely with a CCLS.

Design/Methods:

An ongoing hospital-wide QI initiative, called Tout doux, aims to alleviate procedural pain and distress. To evaluate the impact of the QI initiative on the use of pain and distress strategies for patients with a needle procedure in the ED, we prospectively recorded CCLS interventions in the pediatric ED over a one-year period. More specifically, the number of strategies used for each patient undergoing a needle procedure was reported to track progress throughout the integration of the Tout doux QI project.

Results:

Between September 2021 and August 2022, the CCLS was present for 397 needle procedures (Mean age: 6 yo [0 months-17yo]). For 42% of the cases, it was the child’s first needle procedure. Procedures included IV-line insertions (56%), venous blood draws (30%) and capillary blood tests (14%). Parents were present in 99% procedures. Preparation strategies by the CCLS were possible for 65% of the procedures. Distraction was used for 98% of the procedures, using either active (eg. interactive games [56%]) or passive distraction (eg. video [31%], music [20%]). Deep breathing was used in 46% of procedures. A topical anesthetic was proposed to 70% of children. The proportion of children receiving at least 3 strategies alleviating procedural pain and distress increased to more than 90% during the last 7 months (except for 1 exceptionally busy month) in comparison to 22%-66% for the first 5 months, with the implementation of the Tout doux initiative.

Conclusion(s):

A QI project aiming to improve the management of procedural pain and distress in an institution increased the use of combined coping strategies for children in the pediatric ED. This QI initiative sensibilized the health care providers to the importance of the combined use of strategies, promoted by the presence of the CCLS. Further studies will need to evaluate their impact on patients and the sustainability of their use.